| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
Original Article |
1 Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
2 Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
3 Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
Correspondence: Address correspondence and reprint requests to: Gildy V. Babiera, MD; E-mail: gvbabiera{at}mdanderson.org.
Background: Currently, therapy for breast cancer patients with stage IV disease and an intact primary tumor is metastasis directed; the primary tumor is treated only when it causes symptoms. A recent review suggested that surgery may improve long-term survival in such patients. We evaluated the effect of surgery in such patients on long-term survival and disease progression.
Methods: We reviewed the records of all breast cancer patients treated at our institution between 1997 and 2002 who presented with stage IV disease and an intact primary tumor. Information collected included demographics, tumor characteristics, site(s) of metastases, type/date of operation, use of radiotherapy, chemotherapy and hormonal therapy, disease progression (time to progression and location of progression) in the first year after diagnosis, and last follow-up. Overall and metastatic progression-free survival were compared between surgery and nonsurgery patients.
Results: Of 224 patients identified, 82 (37%) underwent surgical extirpation of the primary tumor (segmental mastectomy in 39 [48%] and mastectomy in 43 [52%]), and 142 (63%) were treated without surgery. The median follow-up time was 32.1 months. After adjustment for other covariates, surgery was associated with a trend toward improvement in overall survival (P = .12; relative risk, .50; 95% confidence interval, .21–1.19) and a significant improvement in metastatic progression-free survival (P = .0007; relative risk, .54; 95% confidence interval, .38–.77).
Conclusions: Removal of the intact primary tumor for breast cancer patients with synchronous stage IV disease is associated with improvement in metastatic progression-free survival. Prospective studies are needed to validate these findings.
Key Words: Breast cancer • Surgery • Stage IV disease • Metastasis • Outcome • Synchronous stage IV disease
This article has been cited by other articles:
 |
|
 |
|
  R. Le Scodan, D. Stevens, E. Brain, J. L. Floiras, C. Cohen-Solal, B. De La Lande, M. Tubiana-Hulin, S. Yacoub, M. Gutierrez, D. Ali, et al. Breast Cancer With Synchronous Metastases: Survival Impact of Exclusive Locoregional Radiotherapy J. Clin. Oncol., March 20, 2009; 27(9): 1375 - 1381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Cady, N. R. Nathan, J. S. Michaelson, M. Golshan, and B. L. Smith Matched Pair Analyses of Stage IV Breast Cancer with or Without Resection of Primary Breast Site Ann. Surg. Oncol., December 1, 2008; 15(12): 3384 - 3395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Dawood, K. Broglio, A. M. Gonzalez-Angulo, A. U. Buzdar, G. N. Hortobagyi, and S. H. Giordano Trends in Survival Over the Past Two Decades Among White and Black Patients With Newly Diagnosed Stage IV Breast Cancer J. Clin. Oncol., October 20, 2008; 26(30): 4891 - 4898. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Gradishar, J. R. Bellon, M. A. Gadd, H. A. D'Alessandro, and K. Braaten Case 30-2008 -- A 47-Year-Old Woman with a Mass in the Breast and a Solitary Lesion in the Spine N. Engl. J. Med., September 25, 2008; 359(13): 1382 - 1391. [Full Text] [PDF]
|
|
|
|
|
|
R. Rao, L. Feng, H. M. Kuerer, S. E. Singletary, I. Bedrosian, K. K. Hunt, M. I. Ross, G. N. Hortobagyi, B. W. Feig, F. C. Ames, et al. Timing of Surgical Intervention for the Intact Primary in Stage IV Breast Cancer Patients Ann. Surg. Oncol., June 1, 2008; 15(6): 1696 - 1702. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Khan Primary Tumor Resection in Stage IV Breast Cancer: Consistent Benefit, or Consistent Bias? Ann. Surg. Oncol., December 1, 2007; 14(12): 3285 - 3287. [Full Text] [PDF]
|
|
|
|
|
|
R. C. Fields, D. B. Jeffe, K. Trinkaus, Q. Zhang, C. Arthur, R. Aft, J. R. Dietz, T. J. Eberlein, W. E. Gillanders, and J. A. Margenthaler Surgical Resection of the Primary Tumor is Associated with Increased Long-Term Survival in Patients with Stage IV Breast Cancer after Controlling for Site of Metastasis Ann. Surg. Oncol., December 1, 2007; 14(12): 3345 - 3351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. J. Petrelli SEER Data: It Can Be Thought Provoking, But Where Do We Go From Here? Ann. Surg. Oncol., August 1, 2007; 14(8): 2173 - 2174. [Full Text] [PDF]
|
|
|
|
|
|
J. Gnerlich, D. B. Jeffe, A. D. Deshpande, C. Beers, C. Zander, and J. A. Margenthaler Surgical Removal of the Primary Tumor Increases Overall Survival in Patients With Metastatic Breast Cancer: Analysis of the 1988 2003 SEER Data Ann. Surg. Oncol., August 1, 2007; 14(8): 2187 - 2194. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Goldhirsch, W. C. Wood, R. D. Gelber, A. S. Coates, B. Thurlimann, H. -J. Senn, and Panel Members Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007 Ann. Onc., July 1, 2007; 18(7): 1133 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Demicheli, W. J. M. Hrushesky, M. W. Retsky, G. Bonadonna, and P. Valagussa Letter to the Editor Ann. Surg. Oncol., April 1, 2007; 14(4): 1519 - 1520. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
